Two years ago, 15 year old Nicole Pushee was a prisoner in her own body, held captive by the image she thought was staring back at her in the mirror.

"It was terrifying," said Pushee. "I wasn't able to go to school. I just got, like, paralyzed in the morning when I got ready."

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More than normal teenage insecurities, Pushee was suffering from a mental illness called Body Dysmorphic Disorder, or BDD.

"They will often describe that they're hideous, or ugly, or that they look disfigured or deformed," said Dr. Sabine Wilhelm, director of the OCD and Related Disorders Program at Massachusetts General Hospital. "Patients often have very little insight into how they really look."

As many as 5 million American men and women suffer from BDD, and most in secret because of shame or fear people will think they're vain. Weight or shape concerns can be common, but more often, it's perceived flaws of the skin, hair, or nose; sometimes all three. Pushee struggled with her face shape.

"Just like a circle of fat," she said.

Left untreated, BDD can become chronic or even worse. Close to half will self-medicate with drugs and alcohol, and according to a study in the Journal of Clinical Psychiatry, nearly 78 percent have suicidal thoughts. One in four will act on them

"The rate of completed suicide in BDD is about 45 times higher than what you might find in the general population," said Wilhelm.

BDD usually starts during adolescence. Knowing the signs can be life-saving.

"If they start avoiding normal activities, such as meeting with friends, going to school," said Wilhelm, "if somebody, for instance, for more than an hour per day engages in repetitive behaviors, such as camouflaging with makeup or clothing, comparing themselves a lot with others, you know, checking the mirrors over and over again."

It's those behaviors, done over and over and over again, for more than an hour each day, that are the biggest red flag. But BDD is treatable. The sooner it's caught, the better And after nearly five months, Pushee finally has her life back.

"It's like weight's lifted off my shoulders," said Pushee.

Another sign of BDD is a deep interest in, or even an addiction to, cosmetic procedures. But instead of solving the problem, the obsession ends up shifting from one body part to another. For more warning signs and information about Mass General Hospital's BDD clinic, please click here.